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Postoperative Analgesia

Use of Intrathecal Morphine in Children

Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University Hospital, Baltimore, Maryland

Jayant K. Deshpande, MD

Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University Hospital, Baltimore, Maryland

Randall C. Wetzel, MD

Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University Hospital, Baltimore, Maryland

James Facker, MD

Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University Hospital, Baltimore, Maryland

Lynne G. Maxwell, MD

Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University Hospital, Baltimore, Maryland

Maurizio Solca, MD

Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University Hospital, Baltimore, Maryland

The identification of opiate receptors in the spinal cord gave rise to the suggestion that the use of intrathecal and epidural narcotics may provide effective and safe postoperative analgesia. The authors retrospectively reviewed the records of ten children who received intrathecal morphine as part of their anesthetic care over the last 2 years. Preservative-free morphine (Duramorph®) in a dose of 0.02 mg/kg was administered to all patients in the lumbar intrathecal space before the start of the surgical procedure. Adequate postoperative analgesia was achieved in the ten children. No patient required supplemental analgesic agents for the initial 15-hour postoperative period. Surgical procedures included exploratory laparotomy, laryngotracheoplasty, and craniofacial reconstruction. As with narcotics administered by any route, intrathecal morphine can cause respiratory depression, and such depression may be delayed for up to 24 hours after the dose. Therefore, the postoperative respiratory status of these children should be monitored for 24 hours after the dose, preferably in an intensive care unit. With this caveat, the use of intrathecal morphine provides safe and effective postoperative analgesia in children undergoing major surgery.

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